Amendment 1 - 36C26224Q1027 0001 Non-Emergent Medical Transportation.pdf

5. PROJECT NUMBER (if applicable)

CODE 7. ADMINISTERED BY

2. AMENDMENT/MODIFICATION NUMBER

CODE

6. ISSUED BY

8. NAME AND ADDRESS OF CONTRACTOR

4. REQUISITION/PURCHASE REQ. NUMBER 3. EFFECTIVE DATE

9A. AMENDMENT OF SOLICITATION NUMBER

9B. DATED

PAGE OF PAGES

10A. MODIFICATION OF CONTRACT/ORDER NUMBER

10B. DATED

BPA NO. 1. CONTRACT ID CODE

FACILITY CODE CODE

Offers must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended, by one of the following methods:

The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offers

E. IMPORTANT:

is extended,

(a) By completing Items 8 and 15, and returning __________ copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted; or (c) By separate letter or electronic communication which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEDGMENT TO BE RECEIVED AT THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY is not extended.

12. ACCOUNTING AND APPROPRIATION DATA

(REV. 11/2016)

is required to sign this document and return ___________ copies to the issuing office. is not, A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT ORDER NO. IN ITEM 10A.

15C. DATE SIGNED

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b).

RESULT IN REJECTION OF YOUR OFFER. If by virtue of this amendment you desire to change an offer already submitted, such change may be made by letter or electronic communication, provided each letter or electronic communication makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.

C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

D. OTHER

Contractor

16C. DATE SIGNED

14. DESCRIPTION OF AMENDMENT/MODIFICATION

16B. UNITED STATES OF AMERICA

Except as provided herein, all terms and conditions of the document referenced in Item 9A or 10A, as heretofore changed, remains unchanged and in full force and effect.

15A. NAME AND TITLE OF SIGNER 16A. NAME AND TITLE OF CONTRACTING OFFICER

15B. CONTRACTOR/OFFEROR

STANDARD FORM 30 PREVIOUS EDITION NOT USABLE

Prescribed by GSA - FAR (48 CFR) 53.243

(Type or print) (Type or print)

(Organized by UCF section headings, including solicitation/contract subject matter where feasible.)

(Number, street, county, State and ZIP Code)

(If other than Item 6)

(Specify type of modification and authority)

(such as changes in paying office, appropriation date, etc.)

(If required)

(SEE ITEM 11)

(SEE ITEM 13)

(X)

CHECK

ONE

13. THIS ITEM APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS,

IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

(Signature of person authorized to sign) (Signature of Contracting Officer)

None

36C262

Department of Veterans Affairs Network Contracting Office 22 VA Loma Linda Healthcare System 11201 Benton Street Loma Linda CA 92357

36C262

Department of Veterans Affairs Network Contracting Office 22 VA Loma Linda Healthcare System 11201 Benton Street Loma Linda CA 92357

To all Offerors/Bidders

36C26224Q1027

06-12-2024

X

See CONTINUATION Page

X 1

The purpose of this amendment is to address the following:

1. Update quantities on line items 0001-0013 for the 90 day period of performance.

2. Correct due date in block 8 on page 1 of the solicitation from June 25,2024 to June 24, 2024, 1:00PM PST

3. Correct block 20 on page 1 from Contractor shall reference Performance Work Statement for Non-Emergent Preventative

4. Maintenance Service to Contractor shall reference Statement of Work for Non-Emergent Medical Transportation.

5. Attach the Vendorization Forms to the solicitation posting on SAM.gov.

CONTINUATION PAGE

A.1 PRICE/COST SCHEDULE

ITEM INFORMATION

ITEM

NUMBER

DESCRIPTION OF

SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

11,897.00 EA __________________ __________________

Wheelchair Van Base Rate Within 20 mile radius.

Contract Period: Base POP Begin: 07-01-2024 POP End: 09-29-2024 PRINCIPAL NAICS CODE: 485991 - Special Needs Transportation

PRODUCT/SERVICE CODE: V212 -

Transportation/Travel/Relocation - Travel/Lodging/Recruitment:

Motor Passenger

20,959.00 EA __________________ __________________

Wheelchair Van - Charge Per Mile Beyond 20 Mile Radius

Contract Period: Base POP Begin: 07-01-2024 POP End: 09-29-2024 PRINCIPAL NAICS CODE: 485991 - Special Needs Transportation

PRODUCT/SERVICE CODE: V212 -

178.00 EA __________________ __________________

Wheelchair Van - Billable Incomplete Pickups

Contract Period: Base POP Begin: 07-01-2024 POP End: 09-29-2024 PRINCIPAL NAICS CODE: 485991 - Special Needs Transportation

PRODUCT/SERVICE CODE: V212 -

51.00 EA __________________ __________________

Wheelchair Van - Billable Waiting Times (Billable in 15 minute

Increments after the first 15 minutes) Contract Period: Base POP Begin: 07-01-2024 POP End: 09-29-2024 PRINCIPAL NAICS CODE: 485991 - Special Needs Transportation

PRODUCT/SERVICE CODE: V212 -

4,808.00 EA __________________ __________________

Hired Car - Base Rate Within 20Miles Radius From Pickup

Contract Period: Base POP Begin: 07-01-2024 POP End: 09-29-2024 PRINCIPAL NAICS CODE: 485991 - Special Needs Transportation

PRODUCT/SERVICE CODE: V212 -

10,356.00 EA __________________ __________________

Hired Car - Charge Per Mile Beyond 20 Mile Radius

Contract Period: Base POP Begin: 07-01-2024 POP End: 09-29-2024 PRINCIPAL NAICS CODE: 485991 - Special Needs Transportation

PRODUCT/SERVICE CODE: V212 -

198.00 EA __________________ __________________

Hired Car - Billable Incomplete Pickups

Contract Period: Base POP Begin: 07-01-2024 POP End: 09-29-2024 PRINCIPAL NAICS CODE: 485991 - Special Needs Transportation

PRODUCT/SERVICE CODE: V212 -

50.00 EA __________________ __________________

Hired Car - Billable Waiting Times Billable in 15 minute Increments after the first 15 minutes) Contract Period: Base POP Begin: 07-01-2024 POP End: 09-29-2024 PRINCIPAL NAICS CODE: 485991 - Special Needs Transportation

PRODUCT/SERVICE CODE: V212 -

5.00 EA __________________ __________________

Afterhours Fee (Transportation services required after normal working hours from 10:00pm to 4:00am) Contract Period: Base POP Begin: 07-01-2024 POP End: 09-29-2024 PRINCIPAL NAICS CODE: 485991 - Special Needs Transportation

PRODUCT/SERVICE CODE: V212 -

3,699.00 EA __________________ __________________

GURNEY VAN BASE RATE WITHIN 20 MILE RADIUS

Contract Period: Base POP Begin: 07-01-2024 POP End: 09-29-2024 PRINCIPAL NAICS CODE: 485991 - Special Needs Transportation

PRODUCT/SERVICE CODE: V212 -

29,836.00 EA __________________ __________________

GURNEY VAN BASE RATE CHARGE PER MILE BEYOND 20 MILE

RADIUS

Contract Period: Base POP Begin: 07-01-2024 POP End: 09-29-2024

PRINCIPAL NAICS CODE: 485991 - Special Needs Transportation

PRODUCT/SERVICE CODE: V212 -

Transportation/Travel/Relocation - Travel/Lodging/Recruitment:

211.00 EA __________________ __________________

GURNEY VAN BILLABLE INCOMPLETE PICKUPS

Contract Period: Base POP Begin: 07-01-2024 POP End: 09-29-2024 PRINCIPAL NAICS CODE: 485991 - Special Needs Transportation

PRODUCT/SERVICE CODE: V212 -

211.00 EA __________________ __________________

GURNEY VAN BILLABLE WAIT TIMES (BILLABLE IN 15 MINUTE

INCREMENTS AFTER THE FIRST 15 MINUTES

Contract Period: Base POP Begin: 07-01-2024 POP End: 09-29-2024 PRINCIPAL NAICS CODE: 485991 - Special Needs Transportation

PRODUCT/SERVICE CODE: V212 -

GRAND TOTAL __________________

A.2 DELIVERY SCHEDULE

ITEM

NUMBER SHIPPING INFORMATION QUANTITY

DELIVERY

DATE

0001 SHIP TO: Veterans Administration VA Long Beach Healthcare System 5901 East 7th Street Long Beach, CA 90822

USA

11,897.00 07/01/2024- 09/29/2024

MARK FOR: Joseph Torres 562-579-8710 joseph.torres@va.gov

FOB: DESTINATION

Non-Emergent Medical Transportation